Medical Staff Services Specialist
- Department: Medical Staff
- Munson Healthcare Cadillac Hospital, Cadillac, MI - Full-Time
- Day shift
- Bachelor’s Degree is required
Entry Requirements
Bachelor's degree in health related field or equivalent experience. Five years' experience in medical staff services/or related field. Certified or eligible as a Certification Provider Credentialing Specialist or Certified Professional Medical Staff Services Manager (within timeframe of certification eligibility).
Demonstrated working knowledge of JCAHO/NCQA, AAAHC and Medicare Conditions of Participation and other regulatory standards with regard to credentialing. Demonstrated working understanding and comfort level of information systems processes with regard to data management and credentialing.
Interpersonal skills to interact effectively with various levels of Hospital management staff. Ability to communicate and process highly confidential information and to exercise and initiate proper judgment and discretion in performing duties.
Organization
This position reports to the Manager of Centralized Verification Center/Medical Affairs. Close working relationship with Credentials Committee Chair and VPMA.
Age of patients served
No clinical contact with patients.
Specific duties
Supports the Mission, Vision and Values of Munson Healthcare
Embraces and supports the Performance Improvement philosophy of Munson Healthcare.
Promotes personal and patient safety.
Has basic understanding of Relationship-Based Care (RBC) principles, meets expectations outlined in Commitment To My Co-workers, and supports RBC unit action plans.
Uses effective customer service/interpersonal skills at all times.
Working knowledge of credentialing based centralized data software (MSO/Morrisey). Must be familiar with crystal reports or access based programs with skills to build database and perform queries for data extraction as required for Medical Staff Services and requests from outside agencies, as well as data extraction and profile compilation for appointment and reappointment forms
Processes medical staff/practitioner applications for (MMC, POMH, GTB, MHC, WSMC and ASC) for appointment as outlined in the Central Credentials Verification Policies and Procedures, closely monitoring information collection, cognitive analysis of all information received; evaluates adequacy and quality. Pursues additional information if necessary after consultation with Manager. This includes initial processing when application comes in, construction of file, data entry into the computer, printing of verification letters, mailing and follow up. Internet queries as appropriate. Must have good working knowledge of regulatory requirements (JCAHO, NCQA and AAAHC, and Medicare Conditions of Participation) to assess thoroughness of application for processing.
Upon completion of verifications, ensures up-to-date hard copy and computer file integrity. Provides report and consultation on all credentialing files to Manager for transmittal to system-wide credentialing bodies. Provides billing statement for accounting.
Responds to customer inquiries for physician information and resolves problems according to established policies and procedures. Working knowledge of HIPAA.
Acts as an Information Technologist with regard to the MSO/Morrisey system-wide database for trouble shooting and integration of new processes.
Provides support to the Manager in carrying out departmental activities.
Prepares draft agenda for MHC Credentials Committee and works closely with the MHC Credentials Committee Chair to facilitate meeting and follow up.
Prepares draft credentialing component of the MEC for review by the Manager.
Performs other duties and responsibilities as assigned.
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